Venous Thromboembolism in Children and Teenagers Admitted for Trauma: A 5-Year Nationwide Perspective.

Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.

Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US.

BACKGROUND: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. MATERIAL AND METHODS: The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years. The primary outcome was mortality; secondary outcomes were prolonged length of stay (LOS) greater than 30 days, readmission within 30 days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome. RESULTS: 157 945 patients were included with 11.0% (n = 17 346) admitted to investor-owned hospitals. The overall mortality rate and prolonged LOS were similar for both groups. The overall readmission rate was 9.2% (n = 13 895), with the rate in investor-owned hospitals at 10.5% (n = 1,739, P < .001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] P < .001) and readmission to a different hospital (OR 1.3 [1.2-1.5] P < .001). DISCUSSION: Severely injured trauma patients have similar rates of mortality and prolonged length of stay in investor-owned vs public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to improve outcomes after trauma must consider hospital ownership and readmission to different hospitals.

Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties.

INTRODUCTION: Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty. METHODS: The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty. RESULTS: There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656). DISCUSSION: Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.

Pancreatic cancer thromboembolic outcomes: rate of thrombosis after adenocarcinoma and non-adenocarcinoma pancreatic cancer surgery.

BACKGROUND: The aim of this study was to define the association of non-adenocarcinoma pancreatic cancer (NACPC) as a risk factor for postoperative cancer-associated thrombosis (CAT). METHODS: We conducted analysis of prospectively collected data of pancreatic cancer surgery. Randomly collected NACPC cases were matched 1:3 to adenocarcinoma cases (ACPC). Variables included comorbidities, demographics, cancer extension, and preoperative Khorana score (KRS). Primary outcome was CAT, which included deep vein thrombosis and pulmonary embolism confirmed by imaging. Categorical variables are presented as percentages, continuous variables as median and range. SPSS, χ2, Cochran-Armitage, and logistic regression were use for analysis. RESULTS: The study included 441 patients. Age 65.9±11.5, male 57% (N.=252), 8% (N.=36) had metastasis. IPMN and neuroendocrine were the most common NACPC. Median follow-up was 449 days in which 90 (20%) patients developed CAT. The odds (Odds Ratio [OR] 1.1, 95% Confidence Interval [CI] 0.6- 1.9, P=0.7) and time to venous thromboembolism were not different between NACPC and ACPC. We analyzed for trends of prophylactic strategies by year of surgery; there was no trend for NACPC (P=0.4) or ACPC (P=0.06). KRS was not associated with CAT. In the multivariate analysis, peripheral artery disease (Adjusted Odds Ratio [ORadj] 5.4, 95% CI: 1.7-17.3), ASA class ≥4 (ORadj 3.6; 95% CI: 1.3-10.4), length of stay >9 days (ORadj: 1.9; 1.2-3.2), and cancer vascular invasion (ORadj: 2.9; 95% CI: 1.6-5.3) were associated with CAT. CONCLUSIONS: The rate of VTE in NACPC after surgery was high and not different than ACPC. Histology type should not govern discrimination in thromboprophylaxis selection or extension.

Herpesvirus saimiri immortalization of Aotus T lymphocytes specific for an immunogenically modified peptide of Plasmodium falciparum merozoite surface antigen 2.

The Plasmodium merozoite surface antigen 2 (MSA2) is one of several candidates for a protective vaccine against malaria. Previous studies have shown that antibodies directed against the MSA2 variable region are not protective and that constant regions are non-immunogenic. However, modified peptides derived from constant regions can be rendered immunogenic and partially protective in Aotus monkeys. In this study, we reveal the establishment, using in vitro Herpesvirus samiri (HVS) infection, of an Aotus monkey T-cell line (AnTMSA2) specific for a modified immunogenic and partially protective peptide derived from a constant and highly conserved region of MSA2 (SKYSNTFINNAYNMSIRRSM). AnTMSA2 is a CD4 T lymphocyte expressing high levels of MHC class II molecules, CD58 and CD2, which are important for proliferation and growth. AnTMSA2 proliferates specifically in response to the modified monomeric MSA2 peptide sequence. It is also capable of specific antigen recognition after glycine-cysteine-polymerized sequence processing and presentation by autologous APC. Interestingly, AnTMSA2 presents cross-reactivity with D-peptide analogues in which residues in positions 8 and 9 were changed for NDID residues. Therefore, at least for this particular sequence, polymerized D-peptides could be used for immunizing animals without losing the immunogenic epitope. AnTMSA2 presents a cytokine profile corresponding to a Th0-like pattern, which suggests that as a result of HVS immortalization AnTMSA2 is in transit from a Th2 to a Th1 pattern. Taken together our results suggest that Th2 T-cell induction and/or T-cell cross-reactivity generation by the modified peptide could be responsible for the immunogenic conversion observed in Aotus monkeys and that D-peptide analogues with longer half-lives could provide an alternative for inducing protective immunity.

Los fenómenos de bioestimulación sexual en ovejas y cabras / Male and female stimulation of estrous activity in sheep and goats

La introducción del macho y hembras en estro a grupos de ovejas y cabras anéstricas, provoca una respuesta ovulatoria sincronizada en los primeros tres a cinco días siguientes (efectos macho y hembra). La señal del macho es principalmente feromonal y desencadena un incremento en la frecuencia y amplitud de los pulsos de la hormona luteinizante (LH). El porcentaje de hembras ovulando en respuesta al olor del macho es menor que cuando existe contacto físico total con el semental, esto último indica que otros sentidos están involucrados en la mediación del fenómeno pero ninguno es indispensable. La poca evidencia existente parece indicar que el mecanismo que desencadena el efecto hembra es el mismo. En un porcentaje variable de hembras, la primera ovulación inducida es silenciosa y es seguida por una fase lútea corta. La fase lútea corta se sigue de un segundo pico de LH y la ovulación inducida origina un cuerpo lúteo de características normales. La profundidad del anestro y la actividad sexual del macho afectan la respuesta. Cuando el anestro es profundo y los machos manifiestan poca actividad sexual el porcentaje de ovulaciones silenciosas y de ciclos cortos se incrementa. En el efecto hembra, la profundidad del anestro reduce también la respuesta. En la presente revisión se discuten todos los sentidos y los factores que probablemente están involucrados en la respuesta a los efectos macho y hembra.

Inducción de actividad ovárica en cabras anéstricas mediante diferentes grados de contacto con hembras en estro / Induction of ovarian activity in anestric goats through different degrees of contac with estrus females

El objetivo del presente trabajo fue evaluar la inducción de la actividad ovárica en cabras anéstricas sometidas a diferentes grados de contacto con cabras inducidas al estro hormonalmente. Se utilizaron 33 cabras identificadas en anestro divididas en cuatro grupos: Grupo I (n = 8), cabras que fueron tratadas con la presencia de nueve cabras en estro inducido (bioestimuladoras); grupo II (n = 9), cabras que no recibieron ningún tratamiento y permanecieron en un corral adyacente al del grupo I, separados mediante un cerco claro; el grupo III (n = 8), cabras sin tratamiento que permanecieron en un corral adyacente al del grupo I, opuesto al del grupo II, separados mediante un cerco opaco; y el grupo IV (testigo, n = 8), cabras que se mantuvieron alejadas de los demás grupos. El grupo bioestimulador respondió al tratamiento hormonal con 66.6 por ciento de hembras con ovulación; mientras que 25 por ciento de las hembras del grupo I ovularon (P > 0.05). Los grupos II, III y IV no presentaron actividad ovárica. Los resultados obtenidos sugieren que en la inducción de cabras anéstricas mediante el efecto hembra se requiere del contacto total con las hembras en estro.

Conducta estral, concentraciones de LH y función lútea en cabras en anestro estacional inducidas a ciclar mediante el contacto con cabras en estro / Estrous behaviour, LH concentracions and luteal function in seasonally anestrous goats exposed to herdmates in estrous

El presente trabajo tuvo como objetivo determinar el efecto de las cabras en estro sobre la actividad ovárica de sus compañeras en anestro estacional. Se utilizaron un total de 30 cabras anéstricas divididas aleatoriamente en tres grupos. El grupo I estuvo formado por 10 cabras inducidas al estro con acetato de melengestrol (MGA) combinado con una inyección intramuscular de gonadotropina sérica de yegua gestante (PMSG); el grupo II estuvo formado por 10 cabras no tratadas y mantenidas en contacto directo con los animales del grupo I durante todo el experimento, y el grupo III, formado por 10 cabras sin tratamiento que se mantuvieron alejadas de los otros dos grupos: En todos los animales se detectaron calores diariamente y se obtuvieron muestras de sangre dos veces por semana con el propósito de determinar las concentraciones de progesterona y establecer la precencia o ausencia de ovulación. Ademas se tomaron muestras de sangre para la determinación de LH cada 2 h desde las 36 hasta las 72 h posteriores a la aplicación de PMSG. Se consideró que un animal tenía actividad ovárica cuando sus valores de progesterona alcanzaron 1 ng/ml. En el grupo I, el 100 por ciento de los animales respondieron con ovulación al tratamiento. En el grupo II el 80 por ciento de los animales ovularon en un periodo de 13 días, y en el grupo III, que actuó como testigo, 40 por ciento de los animales ovularon. Los picos preovulatorios de LH se observaron a las 54.5 9 y 64 6 h para los grupos I y II, respectivamente; no se obvervaron picos de LH en el grupo III. Las diferencias observadas entre los grupos I y II con respecto al grupo III para el porcentaje de presentación de ovulución e inducción de estros fueron significativas (P< 0.05). Se concluye que la presencia de cabras en esto es capaz de inducir el estro, picos preovulatorios de LH y ovulación sincronisada en una proporción considrable de cabras en anestro estacional, lo que indica una inducción real de actividad ovárica y no simplemente una conducta de imitación

Efecto del líquido folicular equino y la somatotropina bovina en la sobrevivencia de embriones ovinos transferidos asincrónicamente / Effect of equine follicular fluid and bovine somatotropin in the survival of ovine embryos asynchronously transferred

La asincronía materno-embrionaria pudiera resolverse incrementando los niveles de progesterona (P4) para promover el desarrollo embrionario, o retrasando la luteólisis. Para tal fin se administró somatotropina bovina (ST), líquido folicular equino (LFE) o ambos, a receptoras de embriones en asincronía. Se recolectaron embriones en 25 donadores el día 6 posestro. Las receptoras se sincronizaron con acetato de fluorogestona y PGF2Ó, y en las asincrónicas de todos los grupos se retiró el progestágeno 3.5 días antes que en las donadoras. Se dividieron en cinco tratamientos: sincronía (sin), n=16; asincronía + LFE (asinlfe), n=19; asincronía + ST (asins), n=7; y asincronía + LFE + ST (asinlfst), n=10. Las concentraciones de progesterona (3.3 ng/ml) fueron mayores en el grupo asinlfe (P< 0.05). Las menores concentraciones (1.4 ng/ml) se presentaron en el asinst. La fase lútea de mayor duración, 16.8 días promedio, se presentó en las no gestantes del grupo asin. En cuatro ovejas del asinlfe se retrasó la luteólisis hasta el día 19. La fertilidad del grupo sin (86.6 por ciento) no fue diferente a la del asin (68.7 por ciento). Los tratamientos no mejoraron la fertilidad a pesar de inrementarse la P4 en las gestantes asinlfe y asinlfst o retrasarse la luteólisis en las asinlfe. Se propone que antes de modificar la asincronía materno-embrionaria se determine el grado de asincronía tolerable de manera natural en los ovinos